PINEAPPLE: PlGF IN EArly Pre-eclampsia Prediction in sierra Leone
THE PROBLEM TO ADDRESS
Availability of placental growth factor (PLGF) test results has been demonstrated to significantly reduce time to clinical confirmation of pre-eclampsia and is associated with a lower incidence of maternal adverse outcomes. Subsequently, National Institute of health and Clinical Excellence (NICE) supports use of PLGF as a clinically and cost-effective algorithm in the management of women at risk of pre-eclampsia.
Current PLGF testing requires venous blood sampling; however a new PLGF point-of-care test (PoCT) has become available which uses capillary blood has recently been developed. PoCT, already widely used in maternity, provides real time results, and eliminates the need for costly laboratory testing and infrastructure. It fits well within midwifery led assessment pathways, enabling risk stratification and appropriate triage of women to Obstetric led care, whilst avoiding unnecessary intervention and over medicalisation of pregnancy in lower risk women.
Pre-eclampsia is one of the commonest causes of maternal death in low-income settings, where diagnostic tests and healthcare provider training are lacking. In this context, a cheap, accurate, easy-to-use test enabling earlier detection and reducing time to treatment could significantly reduce maternal and neonatal deaths.
Hypertensive women between 24 and 37 weeks of pregnancy, admitted to PCMH will be eligible to be included, provided they are willing and able to provide written consent. Each woman will have a PoCT PlGF test, but the results will be blinded, so will not inform clinical management.
Our main study objectives are to:
- To assess PoCT PlGF test performance for prediction of pre-eclampsia within two weeks recommended for delivery by health-care professional
- To compare POCT PLGF performance with ‘miniPIERS’ calculator to identify pregnant women (>24 weeks’ gestation) who develop adverse maternal outcomes associated with pre-eclampsia
- To assess PoCT PlGF test performance according to gestation (<34 weeks’ / <37 weeks’)
- To determine number of eligible women and time needed for study and analysis
- To assess acceptability of POCT PLGF testing to health care professionals